OC-077 (26 Jan 2018-skw) OneCert – PLQ

OneCert Private Label Questionnaire

To be completed and signed by the Distributer (Private Label Company)

 The purpose of this form is to obtain contact information for the distributor identified on the label and
product and/or label details to assure that the distributor has authorized the manufacturing or packing
of their organic products by the operation certified by OneCert.

The certified operation making or packing organic product is responsible for assuring compliance of all products
and labels affixed to those products as approved by OneCert. When that certified operation makes or packs
products for a distributor who will be identified on the label instead of the manufacturer or producer, information
requested on this form must be submitted by the distributor in accordance with NOP 205.201(a)(6) and 205.401(d).
1. Manufacturer or Packer (Certified by OneCert):
Business Name:
     
Contact Person:
     
Address:
     

Phone: Cell: Fax:

                 
Email: Website:
           

2. Distributor (Private Label Company) As Identified on the Label :

Business Name:
     
Legal Business Entity (if different than listed above)
     
Contact Person:
     
Address:
     

Phone: Cell: Fax:

                 
Email: Website:
           
*If the name and address on the label does not match the legal entity, provide an explanation.      

3. List of Products: Check here if more space is needed and list of products is attached.
# Product Name Certificate Category Sizes
(full name of product as it appears on principle (100% Organic, (List all package
display panel of the label—include brand name) Organic, Made with) sizes)
1                  
2                  
3                  
4                  
5                  
6                  
7                  
8                  
9                  
10                  

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OC-077 (26 Jan 2018-skw) OneCert – PLQ
OneCert Private Label Questionnaire
4. Please select the option that applies to your company:
Option A: OneCert is identified on the label as the certifier (this option is available at no additional cost
to the distributor).

You must submit a copy of each label (including each size) for each product to OneCert for review
and approval (electronic copies preferred). When approved, each label will be stamped with the
date of approval and returned to both the distributor and the certified manufacturer. Any subsequent
changes must be submitted to OneCert for approval.

Option B: The distributor is certified by another agency and that certifier will be identi fied on the label.

Certification agency: Contact person:

           
Phone: Email:
           
You must submit a copy of your organic certificate and copies of labels documented as approved by
your agency. Include a label for each size (electronic copies preferred). Name and address on the
certificate and the label must match. Since OneCert certifies the manufacturer or packer, OneCert is
responsible for the compliance and final approval of each product and label.

5. Label Control
1. Who is responsible for designing the labels? Distributor Manufacturer/Packer
2. Who is responsible for printing the labels? Distributor Manufacturer/Packer
3. Who is responsible for the inventory of labels? Distributor Manufacturer/Packer

6. Affirmation by authorized representative of Distributor identified in Section 2:

I affirm that I am an authorized representative of the distributor identified in Section 2. The information on
this form, including the legal entity information, and associated attachments is complete and accurate to the
best of my knowledge. Labels approved by OneCert under Option A will be used exclusively on product made
or packaged at this certified facility. Any changes to labels approved by another certifier under Option B will
be submitted to OneCert whenever such changes are made.

I understand that NOP regulations require OneCert (certifier of the manufacturer/packer) to give final
approval for all labels, even when another certifier may be listed on the label.

Print Name Title

           
(Authorized Representative of Distributor as listed in Section 2)

           
Signature Date
(An electronic signature is acceptable when sent from signatory email.)

US Office: International Office:

OneCert, Inc OneCert International Private Limited
Mail: 1021 D Street, Lincoln, NE 68502 Mail:-H-08, Mansarovar Industrial Area, Mansarovar,
Email: info@onecert.com Jaipur 302020, Rajasthan, India
Fax: 888-475-6044 Email: info@onecertinternational.com

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